Gulich M S, Matschiner A, Glück R, Zeitler H P
Department of General Practice, University of Ulm, Germany.
Br J Gen Pract. 1999 Feb;49(439):119-21.
Sore throat or pharyngitis is an extremely prevalent condition in primary care. There is a diagnostic dilemma in differentiating bacterial and non-bacterial infections for adequate use of antibiotics. Standard diagnostic procedures take too long for an immediate decision.
To evaluate, if near patient C-reactive protein measurement in the general practice surgery improves diagnostic accuracy.
One hundred and seventy-nine consecutive patients with sore throat, from 15 general practitioners (GPs) in southern Germany (phase 1) and 161 consecutive patients from 14 GPs (phase 2), were examined physically and a throat-swab was taken and white blood-cell count (WBC) and CRP-measurement were performed. In phase 1, CRP was measured centrally to assess the method's diagnostic value and the adequate threshold. In the second phase, near patient CRP was measured and CRP values were used to make a diagnosis.
Using relative operating characteristics (ROC) analysis, the diagnostic value of CRP measurement was much better than WBC count (area under curve = 0.85 versus 0.68). All diagnostic parameters improved when using the near patient CRP measurement. Sensitivity went up from 0.61 (95% confidence interval = 0.45-0.75) to 0.78 (0.61-0.90), specificity went up from 0.73 (0.65-0.81) to 0.82 (0.73-0.88). Positive and negative predictive value improved significantly as well. Diagnostic accuracy went up from 70.1% to 81.0%. Out of 1000 theoretical patients with sore throat, 109 more will be treated correctly when using CRP measurement as a diagnostic tool.
Use of near patient CRP measurement can improve diagnostic accuracy in the differentiation of bacterial and non-bacterial pharyngitis in primary care, and potentially results in a more adequate use of antibiotics.
喉咙痛或咽炎在初级医疗保健中极为常见。在区分细菌感染和非细菌感染以合理使用抗生素方面存在诊断难题。标准诊断程序耗时过长，无法立即做出决策。
评估在全科诊所进行即时检测C反应蛋白是否能提高诊断准确性。
对来自德国南部15名全科医生（第一阶段）的179例连续喉咙痛患者以及来自14名全科医生（第二阶段）的161例连续患者进行体格检查，采集咽拭子，进行白细胞计数（WBC）和C反应蛋白（CRP）检测。在第一阶段，集中检测CRP以评估该方法的诊断价值和合适的阈值。在第二阶段，进行即时检测CRP，并使用CRP值进行诊断。
使用相对操作特征（ROC）分析，CRP检测的诊断价值远高于白细胞计数（曲线下面积分别为0.85和0.68）。使用即时检测CRP时，所有诊断参数均有所改善。敏感性从0.61（95%置信区间=0.45 - 0.75）提高到0.78（0.61 - 0.90），特异性从0.73（0.65 - 0.81）提高到0.82（0.73 - 0.88）。阳性和阴性预测值也显著提高。诊断准确性从70.1%提高到81.0%。在1000例理论上的喉咙痛患者中，将CRP检测作为诊断工具时，会有109例得到正确治疗。
在初级医疗保健中，使用即时检测CRP可提高区分细菌性和非细菌性咽炎的诊断准确性，并可能使抗生素的使用更加合理。
